Oesophageal disorders

Question 1

Where does the oesophagus start and end?, state its length

Answer 1

starts at the cricoid cartilage (C6) and ends at the stomach (T11/12)

Question 2

What muscles in the oesophagus produce peristalsis?

Answer 2

circular muscle layer

Question 3

What nerve mediates co-ordinated LOS relaxation and peristalsis?

Answer 3

vagus

Question 4

What maintains the closure of the LOS?

Answer 4

right crus striated muscle of the diaphragm

Question 5

What is heartburn?

Answer 5

retrosternal discomfort or burning associated with waterbrash and cough

Question 6

What is waterbrash?

Answer 6

acid taste in the back of the mouth

Question 7

What is reflux due to?

Answer 7

acid/bile reflux into oesophagus

drugs/food can reduce LOS pressure resulting in increased reflux

Question 8

Does the LOS have a high or low resting pressure?

Answer 8

high

Question 9

What can persistent reflux lead to?

Answer 9

Gastroesophageal reflux disease

Question 10

What is dysphagia?

Answer 10

subjective sensation of difficulty swallowing foods and /or liquids

Question 11

Odynophagia definition

Answer 11

pain with swallowing

Question 12

What 3 things should you ask someone complaining of dysphagia?

Answer 12

type of food - severity
pattern - progressive, intermittent
associated features eg weight loss, cough

Question 13

What are the 2 locations of dysphagia?

Answer 13

oropharyngeal

oesophageal

Question 14

List some causes of dysphagia

Answer 14

benign/malignant stricture
motility disorder
oesophagitis
extrinsic pressure eg lung cancer

Question 15

What investigations are used for dysphagia?

Answer 15

endoscopy, barium swallow, oesophageal pH and manometry

Question 16

What do oesophageal pH and manometry detect?

Answer 16

pH - acid

manometry - peristalsis movements

Question 17

What is hypermotility seen as and how is manometry useful?

Answer 17

diffuse oesophageal spasms with corkscrew appearance on barium swallow
unco-ordinated, exaggerated contractions

Question 18

What is hypomotility caused by and what can it cause?

Answer 18

connective tissue disease, diabetes, neuropathy

reflux due to LOS failure

Question 19

What is achalasia?

Answer 19

functional loss of myenteric plexus in the LOS and oesophagus
failure of LOS to relax leading to functional obstruction

Question 20

Who does achalasia commonly effect?

Answer 20

30-50 yrs, M=F, 1-2 per 100000

Question 21

What are the symptoms of achalasia?

Answer 21

progressive dysphagia, weight loss, chest pain, chest infection

Question 22

How is achalasia treated?

Answer 22

nitrates, CCBs
endoscopic - botulinum toxin and balloon dilation
myotomy

Question 23

What are the complications of achalasia?

Answer 23

aspiration pneumonia, lung disease and cancer

Question 24

What are the symptoms of GORD?

Answer 24

waterbrash, cough, heartburn, sleep disturbance

Question 25

What are the risk factors for GORD?

Answer 25

pregnancy, obesity, smoking, alcohol, hypermotility | male, white, caucasian

Question 26

When must a patient have an endoscopy?

Answer 26

ALARM features

Question 27

What is the aetiology behind GORD without abnormal anatomy?

Answer 27

increase in transient LOS relaxations decrease in gastric and oesophageal emptying decrease in acid clearance and sensitivity to acid

Question 28

What are the 2 types of hiatus hernia that can cause GORD?

Answer 28

sliding | para-oesophageal

Question 29

What are the pathological changes in GORD?

Answer 29

oesophagitis | mucosa exposed to acid leading to cell loss

Question 30

Complications of GORD

Answer 30

ulceration, stricture, glandular metaplasia and carcinoma

Question 31

What is barrett's oesophagus and who is effected more men or women?

Answer 31

metaplasia related to long acid exposure from squamous to mucus secreting columnar men

Question 32

is barretts oesophagus a precursor to SCC or adenoC?

Answer 32

adenocarcinoma

Question 33

What is the treatment for high grade barretts oesophagus dysplasia?

Answer 33

endoscopic mucosal resection radiofrequency ablation rarely an oesophagectomy

Question 34

How do we treat GORD?

Answer 34

lifestyle, gaviscon, PPI | refactory disease may require fundoplication

Question 35

How does oesophageal carcinoma present?

Answer 35

progressive dysphagia, weight loss, haematemesis, odynophagia, cough, chest pain

Question 36

What parts of the oesophagus to SCC and AC effect?

Answer 36

SSC proximal and middle 1/3 | AC - distal oesophagus

Question 37

What are the main causes of SCC and AC?

Answer 37

SSC - smoking and alcohol | AC - barretts oesophagus

Question 38

Explain the reasons why the oesophagus tumours invade easily and have early node involvement

Answer 38

lacks serosa | lamina propria has rich lymphatic supply

Question 39

Oesophageal cancer investigations

Answer 39

endoscopy and biopsy | CT, MRI, EUS, PT, bone scan

Question 40

Only surgical treatment for oesophageal cancer/.

Answer 40

oesophagectomy with adjuvant or neoadjuvant chemotherapy

Question 41

What is adjuvant and neoadjuvant chemotherapy?

Answer 41

adjuvant - after chemo | neoadjuvant - before

Question 42

criteria for oesophagectomy

Answer 42

under 70, no co-morbidities and localised disease

Question 43

Incurable disease treatment?

Answer 43

palliation for dysphagia

Question 44

What is brachytherapy?

Answer 44

radiation seed placed close to the tumour